My wife and I recently had a baby, and both of our employers provide medical insurance. Right now, my wife is on my insurance, but we’re planning to switch her to her own insurance and add our newborn to it.
Here’s the situation:
Our newborn spent a week in the NICU, and my wife also spent a week in the hospital.
My insurance has an OOP (out-of-pocket) limit of $4.9k, while my wife’s is $2k.
I have a few questions:
Will the costs related to my wife’s pregnancy and delivery be covered by my insurance or hers?
When we switch my wife to her insurance, will her OOP and deductible reset for the rest of the year?
I’m considering adding the newborn to my wife’s plan primarily because of the lower deductible and OOP. Are there other factors I should consider before making the switch?
Your wife’s pregnancy and delivery will be covered by your current insurance. However, once the baby is born, any further medical care for the baby will fall under the new insurance. The birth or adoption of a baby is the only qualifying life event (QLE) that is retroactive to the date it occurred.
Congratulations on the new addition of to your family! Here are some of the tips to your questions:
Coverage for Pregnancy and birth: All associated costs, including the newborn’s NICU stay, should be covered by your wife’s insurance plan, which she was on at the time of birth.
Resetting OOP/Deductible and Switching Insurance: Your wife’s OOP limit and deductible will probably be reset for the remainder of the year when she moves to her own insurance. Verify information with her insurance company or workplace.
Including the Newborn in Your Wife’s Plan: When making your decision, take into account reduced OOP limitations, network coverage, prescription coverage, premium expenses and benefit coordination. Speaking with a benefits advisor might be beneficial.
